FIG. 3-31

FIG. 3-32. The distal phalanx of the second toe was carefully mobilized on the toe digital artery and vein on the first web space and both distal nerves.

FIG. 3-33. An attempt was made to reconstitute the nail bed of the toe and residual nail root of the index stump.

FIG. 3-34. DIP joint function has been preserved and partial nail contour restored.

FIG. 3-35. Sensate pulp pinch permits fine manipulative tasks, impossible to achieve with a painful amputation stump.

CASE 9

A woman lost her index and long fingers in a lawnmower accident.

FIG. 3-36. The index finger was successfully replanted, but the long finger failed.

FIG. 3-37. The patient was extremely self-conscious about the loss of her "digital arcade" and requested a second-toe transplant. The toe flexors were cut long in the mid-sole to permit tendon repair in the palm.

FIG. 3-38. Reconstruction of the PIP joint was achieved between the residual articular surface of the proximal phalanx and the articular surface on the proximal end of the toe middle phalanx.

FIG. 3-39. The "digital arcade" has been restored. The patient no longer hides her hand, and function and appearance have been enhanced.

Congenital Hand Deformities

Congenital hand deformities lend themselves well to microsurgical reconstruction by single or multiple toe transplants. 6,7 Unfortunately, with digital agenesis, proximal structures such as tendons, nerves and vessels may not be present to receive the transplant. In addition, such conditions are often bilateral, and sufficient toes may not be present to create bilateral pinch. This is particularly true when the toes are also deformed or missing. Up to four toes can be spared for transplantations without seriously compromising foot function.

CASE 10

A child had congenital loss of four fingers on one hand.

FIG. 3-40. Extent of deformity.

FIG. 3-41. There is only a foreshortened thumb on the radial side of the hand. There are no other metacarpals. A clay model of the proposed transplant has been made.

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